Exam #5- Neurology Pathophysiology Flashcards
(142 cards)
1
Q
temperature regulation
A
varies in response to location, activity, environment, circadian rhythm, and gender
regulation is mediated by hypothalamus
2
Q
thermoreceptors
A
peripheral=skin
central=hypothalamus
3
Q
heat protection
A
chemical reactions of metabolism, skeletal mucle contractions (shivering), chemical thermogenesis
4
Q
temperature conservation
A
vasoconstriction, voluntary mechanisms
5
Q
temperature loss
A
radiation, conduction, convection, vasodilation, decreased muscle tone, sweat evaporation, increased ventilation
6
Q
when does fever happen?
A
when there is a release of pyrogens from leukocytes/other cells in immune response (endogenous pyrogens) and bacteria (exogenous pyrogens)
both are s/s of disease and normal response to disease
hypothalamic thermostat is now reset to a high level
when fever breaks set point goes back to normal
7
Q
benefits of fever
A
kills microorganisms, fever helps infectious processes (decreases iron, zinc, copper that are needed for bacteria to replicate), promotoes lysosomal breakdown and apoptosis of cells, increases lymphocytic transformation and phagocyte motility, augments antiviral inferferon production and phagocytosis
8
Q
older pts and fever
A
decreased or no fever in response to infection
9
Q
kids and fever
A
get higher temps than adults for minor infections and can have febrile seizures
10
Q
hyperthermia
A
NOT mediated by pyrogens
there is no resetting of the hypothalamic set points
at 41 C nerve damage produces convulsions
at 43 C you die
11
Q
heat cramps
A
severe spasmodic cramps in ABD and extremities
following prolonged sweating and sodium loss
happens to those not used to heat/strenuous activity in warm climates
s/s are fever, fast HR, HTN with cramps
12
Q
heat exhaustion
A
prolonged high temperature
s/s are dizziness, weakness, nausea, confusion, syncope
stop working, lie down, rest
stopping activity decreases muscle work with decreases heat production
lying down redistributes vascular volume
13
Q
heatstroke
A
lethal d/t overstressed thermoregulatory center
brain, heart, and thermoregulatory centers don’t work with temps>40.5 C
s/s are cerebral edema, degeneration of CNS, swollen dendrites, renal tubular necrosis, death unless treated
cooling too quickly causes vasoconstriction and limits cooling
14
Q
what is the major sleep center?
A
hypothalamus
15
Q
phases of sleep
A
rapid eye movement (REM) and non rapid eye movement (NREM)
16
Q
REM phase of sleep
A
vivid dreaming
90 minute
1-2 hours after falling asleep
eyes flutter
breathing is irregular
17
Q
NREM phase of sleep
A
slow wave
most of the time is NREM
stages evaluated by EEG
restorative and reparative
growth occurs here
18
Q
three stages of NREM sleep cycle
A
N1- right after you fall asleep (phase is only about 10 minutes)- light sleep
N2- lasts 30-60 minutes, muscles relax, slow waves
N3- deep sleeps, lasts 20-40 minutes, hard to wake up
19
Q
dyssomnias
A
intrinsic and extrinsic sleep disorders and circadian rhythm sleep disorders
20
Q
parasomnias
A
arousal and sleep wake transition disorders and REM sleep disorders
21
Q
OSAS
A
trouble breathing while you sleep related to upper airway obstruction and is related to decreased O2 and increased CO2
22
Q
risk factors for OSAS
A
obesity, male, age
23
Q
s/s of OSAS
A
snoring, gasping, apnea 10-30 seconds, fragmented sleep, daytime sleepiness
24
Q
pathophysiology of OSAS
A
obstruction d/t soft palate or base of tongue collapsing against pharyngeal walls d/t decreased muscle tone during REM sleep
negative introthoracic pressure wakes up pt
25
systemic illnesses associated with OSAS
HTN, pulmonary HTN, HF, nocturnal cardiac dysrhythmias, MI, CVA
26
people spend most time in what phase of sleep?
NREM
27
age-related macular degeneration (AMD)
drusen (retinal) waste products build up in deep retinal layers
wet AMD is the worst, dry is most common
28
wet AMD
too many abnormal vessels leads to leak and bleed which leads to retinal detachment
29
dry AMD
loss of retinal pigment epithelium photoreceptors with overall atrophy of cells
30
glaucoma
intraocular pressure>normal pressure
build up of aqeous humor fluid
trabecular meshwork
damage to the optic nerve
31
scotoma
a defect of the central field of vision
32
conductive hearing loss
impaired sound from outer to inner ear
33
sensorineural hearing loss
impaired organ of corti or its central connections
34
presbycusis hearing loss
a type of sensorineural hearing loss
age related hearing loss (high frequencies)
35
mixed hearing loss
conductive and sensorineural
36
functional hearing loss
no reason but could be emotional/psychological factors
37
vertigo
spinning feeling that occurs from inflammation of ear's SEMICIRCULAR CANALS
38
arousal
state of being AWAKE
mediated by RAS
**breathing patterns, oculomotor responses, and pupil changes=change in arousal**
39
awareness
cognitive functions that embody awareness of self, environment, and mood
CONTENT of thought
40
coma
no verbal response to external environment or any stimuli
noxious stimuli (deep pain, suctioning produces movement)
41
light coma
purposeful movement with stimulation
42
deep coma
no response to any stimulus
43
brain death
brain will not recover and can't maintain body's homeostasis
state laws: entire brain, brainstem, and cerebellum stop functioning
brain autolyzes (self-digests)
44
cerebral death
cerebral hemispheres die but not brainstem or cerebellum
braintstem may maintain normal respiration and cardiac fucntions, temp control, and GI function
45
pathophysiology of seizures
sudden, impermanent alteration of brain function caused by explosive, disorderly discharge of cerebral neurons
46
generalized seizure
neurons bilaterally
ex: absent, myoclonic, clonic, tonic-clonic, atonic
47
partial (focal) seizure
neurons unilaterally
begins in specific region of cortex
ex: simple, complex
48
secondary generalization seizure
partial becomes generalized
49
status epilepticus
emergency
seizure lasts longer than 5 minutes, 2nd seizure occurs before LOC is regained from 1st, or 1 seizure lasts longer than 30 minutes
50
aura
partial seizure (weird sensation) leads to generalized seizure
51
prodromal seizure
early s/s like malaise, HA, depression
52
tonic seizure
contraction
53
clonic seizure
relaxation
54
post ictal seizure
period immediately following end of seizure
55
broca aphasia
can understand, but can't communicate
expressive dysphagia
56
wernicke problem
can't understand (verbal/reading)
57
delirium
acute
onset abrupt
ANS is overactive
common in ICU's, post surgeries, withdrawal (ETOH, narcs)
58
dementia
progressive
onset gradual
progressive nerve cell degeneration and brain atrophy
age is greatest risk factor
59
a major difference between delirium and dementia is what?
related to degeneration of nerve cells
60
pathophysiology of alzheimers
exact cause unknown, but thought to be mutation for encoding amyloid precursor protein, alteration in apoliporotein E, or loss of NT stimulation of choline actyltransferase
early onset is AUTOSOMAL DOMINANT
61
s/s of alzheimers
neurofibrillary tangles, senile plaques, amyloid deposits (limit blood flow), forgetfulness, emotional upset, disoriented, confused, lack of concentration, decline in abstraction, problem solving, judgement
62
diagnosis of alzheimers
when you rule out other causes
definitive on postmortem exam
63
herniation
brain tissue is pushed from one compartment to another
from infection, hemorrhage, tumor, ischemia, infarct, hypoxia
64
vasogenic cerebral edema
**disruption of BBB**
caused by increased permeability of capillary endothelium of brain after injury to vasculature
65
cytotoxic cerebral edema
metabolic
**BBB is not disrupted**
toxic factors impact brain
failure of active transport system
cells swell d/t loss of K+ and gain of Na+ (then H2O follows Na+)
66
interstitial cerebral edema
caused by trans-ependymal movement of CSF from ventricles into extracellular spaces of brain tissues
67
hydrocephalus
caused by interference in CSF flow
too much fluid within cranial vault, subarachnoid space, or both
68
decreased reabsorption with hydrocephalus
ex: blockage of arachnoid vili from SAH or infection
69
increased fluid production with hydrocephalus
ex: choroid plexus tumor
70
obstruction within ventricular system with hydrocephalus
tumor or congenital malformation
71
communicating (extra-ventricular) hydrocephalus
from impaired absorption
normal pressure hdyrocephalus
72
non-communicating hydrocephalus
blockage occurs along narrow pathways that connect ventricular system
most common narrowing of aqueduct of sylvius "aqueductal stenosis" between 3rd and 4th
73
acute hydrocephalus
develops in several hours
rapidly increases ICP and deterioration
74
obstructive sources of hydrocephalus are classified as what?
non-communicating hydrocephalus
75
paresis
weakness
76
paralysis
loss of motor function
77
upper motor neuron syndromes
spastic paresis or paralysis
associated with HYPERREFLEXIA
SPINAL SHOCK- complete paralysis, loss of reflexes, below lesion
78
lower motor neuron syndromes
**dysfunction impairs voluntary and involuntary movement**
**flaccid paresis or flaccid paralysis- muscle has reduced or absent tone**
associated with HYPOREFLEXIA or AREFLEXIA
79
what is an example of a lower motor neuron disease?
drop foot
80
huntington disease
autosomal dominant hereditary degenerative disorder
short arm chromosome 4
enlargement of the frontal horns of the lateral ventricles
81
s/s of huntington disease
abnormal movement (CHOREA) and progressive dementia
82
parkinson disease
severe breakdown of basal ganglia involving the dopaminergic nirgostriatal pathway (dopamine secreting)
loss of dopaminergic pigmented neurons in substantia nirga pars compacta with dopaminergic deficiency in putemen portion of striatum DECREASES activity of DIRECT motor pathway (normally FACILITATES movements) and INCREASES activity of INDIRECT motor loop (normally INHIBITS movement)
83
s/s of parkinson's disease
parkinsonian tremor, rigidity, bradykinesia (slowed movement), abnormal posture, cognitive-affective s/s, tremor at rest, cogwheel rigidity, hypoakinesia, stooped posture, not sleeping, fatigue, pain, autonomic dysfunction, depression, dementia with or without psychosis
84
decorticate posturing
flexed upper extremities and close to body
brainstem is NOT inhibited by motor function of cerebral cortex
85
decerebrate posturing
angel wings
severe brain and brainstem injury
86
central sensitization
nonpainful stimuli creates a pain response
87
contusion
brain bruise
coup-contrecoup
88
laceration
brain tissue tear
89
extradural (epidural) hematoma
blood ABOVE dura mater
90
subdural hematoma
blood between dura and arachnoid
91
intracerebral hematoma
bleeding IN the brain
92
open brain injury
head trauma
skull fracture with exposed cranial vault
93
diffuse brain injury
d/t head rotation (primary) or shaking
brain undergoes shearing stress which leads to axonal damage (concussion leads to severe DAI)
O2 free radials r/t secondary injury
categories are mild concusion, classical consussion, mild/mod/severe DAI
94
three grades of mild concussion
I. confusion, disorientation, momentary amnesia
II. momentary confusion and retrograde amnesia
III. confusion with retrograde and anterograde amnesia with loss of consciousness
**no loss of consciousness with grade I and II**
95
grade IV concussion
cerebral systems are disconnected from brain stem and RAS
physiologic and neuro dysfunction without bad anatomic disruption
loss of consciousness<6 hours
post concussive syndrome
96
post concussive syndrome
HA, cognitive impairments, psych and somatic complaints, cranial nerve S/S
happens with a grade IV concussion
97
diffuse axonal injury (DAI)
form of TBI
98
mild DAI
coma 6-24 hours
residual impairments
decerebrate/decorticate posturing
99
moderate DAI
coma >24 hours
widespread impairment through cerebral cortex and diencephalon
ACTUAL TEARING of some AXONS in both hemispheres
recovery is incomplete
decerebrate and decorticate posturing
100
severe DAI
many axons are messed up extending to diecephalon and brainstem
high mortality
101
pathophysiology of spinal cord trauma
occurs from vertebral injuries
simple fx, compressed fx, communited fx and dislocation
102
complete spinal cord transection
loss of motor function
muscles are flaccid
lost reflexes
lost pain, temp, touch, proprioception, respiratory impairment
103
s/s of spinal cord trauma
paraplegia- paralysis of LE
quadriplegia- paralysis of all extremities
104
spinal shock
a result of spinal cord trauma
loss of motor, sensory, reflex, and autonomic functions below cut across area
105
partial spinal cord transection
asymmetric flaccid motor paralysis/reflex loss, some senses
106
brown-sequard syndrome
ipsilateral paralysis/loss of touch
contralateral loss of pain and temp
107
central cord syndrome
motor deficits>UE than LE
108
anterior cord syndrome
loss of motor, pain, temp
intact=touch, pressure, position, vibration
109
posterior cord syndrome
impaired light touch and proprioception
110
cauda equina syndrome
LE motor deficits, sensorimotor dysfunction
B/B and sexual dysfunction
111
autonomic hyperreflexia (dysreflexia)
**massive/uncompensated heart response to stimulation of SNS**
sudden/dangerous increase in BP (life threatening)
112
s/s of autonomic hyperreflexia
HTN, bradycardia, pounding HA, blurred vision, piloerection
113
thrombotic stroke
arteries supplying brain occluded from thrombi d/t atherosclerosis and inflammatory disease
damaged artery walls
114
embolic stroke
fragment breaks off a thrombus that's formed outside of the brain d/t a-fib
115
hemorrhagic stroke
d/t HTN, ruptured aneurysm, AV malformations, cavernous angioma or from TBI
116
lacunar stroke
really tiny infarct in tiny vessels d/t lipohyalinosis, subintimal lipid-loading foam cells, or fibrinoid materials that thicken the arterial walls
r/t smoking, HTN, DM
117
a patient is diagnosed with a fib and then has a CVA
embolic stroke
118
TIA
BRIEF episode of neuro dysfunction d/t focal disturbance/brain/retinal ischemia
s/s last<1 hour
thrombus particles lead to INTERMITTENT blockage
119
subarachnoid hemorrhage (SAH)
blood escape from defective/injured vasculature into subarachnoid space
120
s/s of subarachnoid hemorrhage
VASOSPASM- d/t blood breakdown
free radicals disrupt blood vessel layers and release inflammatory factors
delayed cerebral ischemia
thunderclap HA, N/V, loss of LOC, neuro problems d/t increased ICP
KERNIG/BRUDZINSKI sign: when the patient is lying with the thigh flexed on the abdomen, the leg cannot be completely extended. when the patient's neck is flexed, flexion of the knees and hips is produced; when the lower extremity of one side is passively flexed, a similar movement is seen in the opposite extremity
121
intracranial aneurysm
d/t defect in vascular wall
s/s is acute SAH, intracerebral hemorrhage, or a combination
122
migraine
genetic and environment
phases (premonitory, aura, HA)
unilateral throbbing, worse with movement, N/V, photophobia
123
cluster headaches
trigeminal activation
unilateral TRIGEMINAL distribution of severe pain with ipsilateral autonomic s/s (tearing on affected side, ptosis of same eye, stuffy nose)
124
tension type headache
central and peripheral mechanism
feeling of a tight band/pressure around head with gradual onset
125
bacterial meningitis
infection of pia mater and arachnoid of fluid or subarachnoid space
bacteria makes pus
vessels are hyperemic and netrophils move to subarachnoid space
inflammatory reaction leads to exudation
126
aseptic meningitis
viral, non-purulent, lymphocytic
limited to meninges
127
fungal meningitis
chronic, less common
128
meningitis s/s
depends on type
can be throbbing HA, neck stiffness, rigidity, decreased responsiveness, kernig and brudzinski
129
encephalitis
acute febrile illness (viral) with nervous system affected
130
s/s of encephalitis
fever, delirium, confusion, seizures, involuntary movement, increased ICP
131
MS
acquired autoimmune
it's a progressive, **inflammatory, DEMYELINATION disorder of CNS**
**scarring, plaque formation, and loss of axons**
132
mixed MS
optic signs
brainstem signs (diplopia, vertigo, nystagmus, dysarthria)
133
spinal MS
spinal tracts and dorsal column involved
weakness, numbness, or both
spastic ataxia
bladder/bowel s/s
134
cerebellar MS
motor ataxia, hypotonia, asthenia
135
pathophysiology of ALS
upper and lower motor neurons of cerebral cortex, brainstem, and spinal cord affected
DEGENERATION of NON-MOTOR NEURONS in cortices and spinal cord
136
s/s of ALS
disease
progressive weakness
respiratory failure and death
137
myasthenia gravis pathophysiology
acquired chronic autoimmune disease resulting from defect in nerve impulse transmission at NMJ
**IgG antibody is produced against acetylcholine receptors**
138
s/s of myasthenia gravis
weakness/fatigue of muscles of eyes and throat
diplopia and trouble chewing, talking, or swallowing
**c/o fatigue after exercise and history of recurring URI's**
139
myasthenia crisis
severe muscle weakness
quadriparesis/quadriplegia, respiratory problems with SOB, extreme problems with swallowing
140
cholinergic crisis
can be d/t drug overdose
looks like myasthenic crisis BUT it happens 30-60 minutes **after taking anticholinesterase med**
141
s/s of cholinergic crisis
diarrhea, cramping, fasciculation, decreased HR, pupil constriction, increased salivation, increased sweating
142
myasthenia gravis is the result of what?
autoimmune destruction of acetylcholine receptors
